RESUMO
This study aimed at evaluating the validity of cone-beam computed tomography (CBCT) for assessing mandibular bone quality using the Klemetti classification. The morphology of the endosteal mandibular cortex of 30 (60 hemi-mandibles) postmenopausal women between the ages of 45 and 80 years was evaluated based on the Klemetti classification in panoramic radiographs used as reference images. Afterwards, panoramic reconstruction and cross-sectional slices of CBCT examinations of these patients were analyzed and categorized according to the same classification. All the images were assessed by two oral radiologists. The McNemar-Bowker test compared the agreement between the CBCT images and the reference images. No differences were found between the diagnostic results based on panoramic radiography and panoramic reconstruction. However, the mean scores for the cross-sectional evaluation were higher, and the results, statistically different from the others. Based on the disagreement found between the panoramic radiographs and the CBCT cross-sectional slices, the Klemetti classification is not an adequate means of assessing bone quality with CBCT. On the other hand, the higher values found for the cross-sectional slices could be associated with better visibility on the CBCT images.
Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Mandíbula/diagnóstico por imagem , Doenças Mandibulares/diagnóstico por imagem , Osteoporose Pós-Menopausa/diagnóstico por imagem , Radiografia Panorâmica/métodos , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Humanos , Doenças Mandibulares/classificação , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoporose Pós-Menopausa/classificação , Valor Preditivo dos Testes , Reprodutibilidade dos TestesRESUMO
Abstract This study aimed at evaluating the validity of cone-beam computed tomography (CBCT) for assessing mandibular bone quality using the Klemetti classification. The morphology of the endosteal mandibular cortex of 30 (60 hemi-mandibles) postmenopausal women between the ages of 45 and 80 years was evaluated based on the Klemetti classification in panoramic radiographs used as reference images. Afterwards, panoramic reconstruction and cross-sectional slices of CBCT examinations of these patients were analyzed and categorized according to the same classification. All the images were assessed by two oral radiologists. The McNemar-Bowker test compared the agreement between the CBCT images and the reference images. No differences were found between the diagnostic results based on panoramic radiography and panoramic reconstruction. However, the mean scores for the cross-sectional evaluation were higher, and the results, statistically different from the others. Based on the disagreement found between the panoramic radiographs and the CBCT cross-sectional slices, the Klemetti classification is not an adequate means of assessing bone quality with CBCT. On the other hand, the higher values found for the cross-sectional slices could be associated with better visibility on the CBCT images.
Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Radiografia Panorâmica/métodos , Doenças Mandibulares/diagnóstico por imagem , Osteoporose Pós-Menopausa/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Mandíbula/diagnóstico por imagem , Doenças Mandibulares/classificação , Densidade Óssea , Variações Dependentes do Observador , Osteoporose Pós-Menopausa/classificação , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Pessoa de Meia-IdadeRESUMO
Florid osseous dysplasia (FOD) is a benign condition of the jaws in which the normal architecture of bone is replaced by a fibrous tissue containing a variable amount of bone and cementum-like tissue. This lesion is most commonly seen in middle aged black women. FOD appears as dense, lobulated masses, often symmetrically located in the mandible, rarely in the maxilla. The lesion is usually asymptomatic and benign. However, a secondary infection may occur and its treatment can be difficult and complicated. This paper reports the case of two patients. The first one is a white woman aged 65 and the second one is a black woman aged 70, both diagnosed with FOD, revealed by secondary infections. The diagnosis was based on clinical and radiographic findings, as biopsy is contraindicated. Radiological and clinical features of FOD and its management will be also discussed on the basis of recent literature.
La displasia ósea florida (DOF) es una patología benigna del maxilar y mandíbula en la que se sustituye la arquitectura normal del hueso por un tejido fibroso que contiene una cantidad variable de tejido óseo y cementoide. Esta lesión es más frecuente en mujeres negras de edad media. La DOF aparece como una masa densa, lobulada, a menudo situada simétricamente en la mandíbula, rara vez en el maxilar. La lesión suele ser asintomática y benigna. Sin embargo, una infección secundaria puede ocurrir y su tratamiento puede ser difícil y complicarse. Este artículo reporta el caso de dos pacientes. La primera es una mujer blanca de 65 años y la segunda es una mujer negra de 70 años, ambas diagnosticadas con DOF, revelada por infecciones secundarias. El diagnóstico se basó en los hallazgos clínicos y radiológicos, ya que la biopsia está contraindicada. Las características clínicas y radiológicas de la DOF y su manejo son discutidos en base a la literatura reciente.
Assuntos
Humanos , Feminino , Idoso , Displasia Fibrosa Óssea/cirurgia , Displasia Fibrosa Óssea/complicações , Displasia Fibrosa Óssea/diagnóstico , Doenças Mandibulares/cirurgia , Doenças Mandibulares/complicações , Doenças Mandibulares/diagnóstico , Biópsia , Displasia Fibrosa Óssea/classificação , Doenças Mandibulares/classificação , Radiografia PanorâmicaRESUMO
INTRODUCTION: Odontogenic cysts constitute a group of frequent intraosseous lesions characteristic in the maxillary bones and one of the main causes of the destruction of these bones. In Chile there are no retrospective studies of these lesions as a whole. OBJECTIVE: The purpose of this study is to determine the frequency of these lesions in so far as they were diagnosed and registered in the Referral Institute for Oral Pathology (IREPO) of the University of Chile in two age groups as well as to analyze and to compare the data obtained with the data published in previous studies. MATERIAL AND METHOD: We studied the records from IREPO of the University of Chile for the period between 1976 and September, 2004; and we determined the frequency according to age, gender and site of each of these lesions. We compare two age groups: younger than or equal to 15 years old and older than 15 years old. Those cases in which the information did not suffice for the purposes of analysis were not considered. All the histological slides were reclassiffed according to the diagnostic criteria included in the Histological Typification of the World Health Organization. RESULTS: We found 2.944 odontogenic cysts (OC), of which 1.935 (65.7%) were inflammatory cysts and 1.009 were developmental cysts. Out of this total, there were 1.554 cysts (52.8%) in men and 1.390 (47.2%) in women. The most frequent cysts were 1.494 radicular cysts (50.7%), 546 dentigerous cysts (18.5%), 421 keratocysts (14.3%) and 328 residual cysts (11.1%). These four varieties represent 94.7% of the OC , that is, 2789 cases. In the population younger than or equal to 15 years of age the developmental cysts (354 cases) are more frequent than the inflammatory cysts (155 cases), the most frequent being dentigerous cysts (240 cases).
Assuntos
Doenças Mandibulares/epidemiologia , Doenças Maxilares/epidemiologia , Cistos Odontogênicos/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Chile/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doenças Mandibulares/classificação , Doenças Maxilares/classificação , Pessoa de Meia-Idade , Cistos Odontogênicos/classificação , Estudos Retrospectivos , Distribuição por SexoRESUMO
We report two cases of an uncommon odontogenic lesion, previously described as adenomatoid dentinoma. They were well-circumscribed unilocular radiolucent lesions exhibiting discrete radiopacities, located in the left mandibular third molar region. Microscopically they were composed of odontogenic hard and soft tissues, similar to a dental germ. Dental papilla and dentin were easily identified. Odontogenic epithelium formed adenomatoid-like structures, and by scanning electron microscopy a layer of enamel was seen in contact with the dentin. Based on these clinical, radiographic, histological and electron microscopical features we proposed the diagnosis of adenomatoid odontogenic hamartoma. Treatment consisted of surgical removal, and no recurrence was observed. In our opinion all similar cases previously reported pertain to the same spectrum of this lesion and thus should be named as suggested above. Moreover, ultrastructural observations using 5 microm sections can be useful to better characterize the presence of hard tissues.
Assuntos
Hamartoma/classificação , Doenças Mandibulares/classificação , Neoplasias Mandibulares/classificação , Tumores Odontogênicos/classificação , Terminologia como Assunto , Adolescente , Ameloblastos/patologia , Tecido Conjuntivo/patologia , Esmalte Dentário/patologia , Papila Dentária/patologia , Dentina/patologia , Epitélio/patologia , Feminino , Hamartoma/patologia , Humanos , Masculino , Doenças Mandibulares/patologia , Microscopia Eletrônica de Varredura , Germe de Dente/patologiaRESUMO
The aim of the present study was to evaluate the clinical, radiographic and histological characteristics of idiopathic bone cavities from the Oral Pathology archives at Universidade Federal de Minas Gerais. Forty-three cases were retrieved. Age, sex, some radiographic variables and morphological variables measured of the connective tissue, were studied. The results showed the men who developed cavities tended to be younger than women (median 16 years (range 11-48) compared with 18 (12-64)). Radiographically rounded lesions that were single, unilocular, and small were more common in younger patients. While rounded cavities occurred mainly in the anterior region, cavities with interdental scalloping occurred in the posterior area. The median age of the patients with thin connective tissue on the wall of the bony cavity was lower than that of those with a thicker lining. In conclusion, the present study shows that there is a significant relation between age and sex, radiographic and histological variables. These findings may contribute to the diagnosis of idiopathic bone cavities.
Assuntos
Cistos Maxilomandibulares/classificação , Adolescente , Adulto , Fatores Etários , Brasil , Criança , Tecido Conjuntivo/diagnóstico por imagem , Tecido Conjuntivo/patologia , Feminino , Humanos , Cistos Maxilomandibulares/diagnóstico por imagem , Cistos Maxilomandibulares/patologia , Masculino , Doenças Mandibulares/classificação , Doenças Mandibulares/diagnóstico por imagem , Doenças Mandibulares/patologia , Pessoa de Meia-Idade , Radiografia , Fatores Sexuais , Estatísticas não ParamétricasRESUMO
BACKGROUND: The use of graft materials with guided tissue regeneration (GTR) in Class II furcation defects is aimed at improving the outcome of the regenerative technique. In this regard, however, there are a limited number of studies discussing the results obtained when GTR and graft materials are used in the treatment of Class II furcation defects. Furthermore, most studies employ either allogeneic or autogenous materials. The present trial sought to determine whether the use of a bovine-derived anorganic bone (ABB) in conjunction with GTR influenced the outcome of mandibular Class II furcation treatment. METHODS: This study included 14 patients who provided 15 pairs of similar periodontal defects. Each defect was randomly assigned to treatment with either a cellulose membrane in combination with bovine-derived anorganic bone (GTR+ABB) or membrane alone (GTR). Following basic therapy, baseline measurements were recorded including probing depth (PD), clinical attachment level (CAL), and gingival margin position (GMP). Hard tissue measurements were performed during surgery to determine alveolar crestal height (CEJ-AC), and vertical (VDD) and horizontal defect depth (HDD). Membranes remained in position for at least 4 weeks. After 6 months, all sites were re-entered and soft and hard tissue measurements were recorded. RESULTS: Both surgical procedures resulted in statistically significant probing depth reduction and gain in clinical attachment levels, with no significant difference between groups. Gingival recession was more pronounced in the GTR+ABB group (0.87 +/- 0.83 mm), but not statistically different from the GTR group (0.46 +/- 1.19 mm). Vertical defect resolution was significant in both groups (GTR: 1.60 +/- 1.50 mm; GTR+ABB: 1.80 +/- 2.11 mm), without differences between groups. Only horizontal furcation resolution (GTR: 2.47 +/- 0.99 mm; GTR+ABB: 3.27 +/- 1.39 mm) was significantly different between groups (P <0.05). CONCLUSIONS: The use of ABB with GTR techniques improved horizontal defect resolution in mandibular Class II furcation defects, but did not yield superior results regarding soft tissue changes when compared to sites treated with GTR alone. Evaluation of a larger sample could indicate differences and advantages between the evaluated approaches and confirm the real necessity of associating filling materials with GTR.